Ruttan Timothy K, Sanders Arthur B
Department of Emergency Medicine, University of Arizona, Tucson, Arizona 85724-5057, USA.
J Emerg Med. 2012 Oct;43(4):e227-9. doi: 10.1016/j.jemermed.2010.02.031. Epub 2010 Apr 24.
Acute esophageal rupture is a rare emergency that must be diagnosed quickly and treated aggressively to avoid significant morbidity and mortality. The typical presentation of this disease includes chest pain, and the diagnosis is challenging when cardinal features such as this are absent.
This case report discusses an atypical presentation of esophageal rupture in a patient with a predisposing condition and highlights the diagnostic and cognitive difficulties involved in making the appropriate diagnosis.
We report a case of a 51-year-old woman who presented to the Emergency Department with hypotension and an emergency medical services report of hematemesis. The patient had a documented history of upper gastrointestinal bleeding and Zollinger-Ellison syndrome during her past hospitalizations; however, the patient was not anemic and had a negative stool guiac despite symptoms for 3 days. A subsequent chest radiograph led to the diagnosis of esophageal rupture with a bilateral pneumothorax requiring thoracostomies. She reported no chest pain.
The esophageal rupture and subsequent hypotension was likely secondary to the combination of her Zollinger-Ellison syndrome and recent vomiting episodes. It is important to avoid premature diagnostic closure and think about unusual presentations of emergent conditions such as esophageal rupture.
急性食管破裂是一种罕见的急症，必须迅速诊断并积极治疗，以避免严重的发病率和死亡率。这种疾病的典型表现包括胸痛，而当缺乏诸如此类的主要特征时，诊断具有挑战性。
本病例报告讨论了一名具有易患因素的患者食管破裂的非典型表现，并强调了做出正确诊断所涉及的诊断和认知困难。
我们报告一例51岁女性患者，她因低血压被送往急诊科，紧急医疗服务报告显示有呕血症状。该患者既往住院时有上消化道出血和卓-艾综合征的记录；然而，尽管有3天的症状，但患者并无贫血，粪便隐血试验呈阴性。随后的胸部X光片诊断为食管破裂并伴有双侧气胸，需要进行胸腔造口术。她自述无胸痛。
食管破裂及随后出现的低血压可能是其卓-艾综合征和近期呕吐发作共同作用的结果。避免过早做出诊断结论并考虑诸如食管破裂等紧急情况的异常表现非常重要。
